Complications can be divided into the
General complications of any operation
Specific complications of individual operations
According to time of occurance
Immediate (during operation or within the next 24 hours).
Early postoperative (during the first postoperative week).
Late postoperative (up to 30 days after operation) and long-term
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Principal categories of surgical complications
1. Complications predisposed to by intercurrent ‘medical
disorders, e.g. ischaemic heart disease, chronic respiratory
disease or diabetes mellitus.
2. Complications of anesthesia
3. General complications of operations, e.g. haemorrhage or
wound infection.
4. Complications of any surgical condition, e.g. pulmonary
embolus, chest or urinary tract infection.
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2. Complications of anesthesia
1.
Injection site - pain, hematoma, delayed
recovery of sensation (direct nerve trauma),
infection
Systemic effects of local anesthetic agent
*allergic reactions (very rare).
*Toxicity due to either excess dosage, or inadvertent
intravenous injection. Toxic effects include: dizziness, tinnitus.
nausea and vomiting, bradycardia
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* Failure of anesthetic ( anatomical difficulties or technical failure).
* Headache or minor intrathecal haemorrhage.
* Intra-thecal bleeding
*In spinal anesthesia, if the anesthetic agent flows too far proximally,
respiratory paralysis may occur.
*Permanent nerve or spinal cord damage - injection of incorrect drug.
*Paraspinal infection - introduced by the needle.
*Systemic complications (severe hypotension or postural hypotension).
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:
*Direct trauma to, mouth or pharynx, General
e.g. teethanesthesia:
*allergic reactions to anesthetic agents:
*Minor effects, e.g. postoperative nausea and vomiting.
*Major effects: e.g. cardiovascular collapse
*Inadvertent trauma:
*Slow recovery from anesthetic
*Hypothermia
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COMPLICATIONS OF ANAESTHESIA
 DROWSINESS
 PAIN AND DISCOMFORT
 NAUSEA AND VOMITING
 CHEST INFECTION
 DEEP VEIN THROMBOSIS
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3. GENERAL COMPLICATIONS OF OPERATIONS
The main complications of any operation are hemorrhage,
infection, delayed wound healing, surgical damage to related
structures and inadvertent trauma to the patient in theatre.
1. HAEMORRHAGE
Pre- operative Hemorrhage:
Hemorrhage occurring during an operation (primary haemorrhage) should be
controlled by the surgeon before the operation is completed.
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3. GENERAL COMPLICATIONS OF OPERATIONS
2. Early Postoperative Hemorrhage:
Hemorrhage during the immediate postoperative period usually indicates
inadequate operative haemostasis or unrecognized trauma to a blood vessel.
After major blood loss requiring large volume transfusion of stored blood.
3. Later Postoperative Hemorrhage
Hemorrhage occurring several days after operation is usually related to
infection which erodes vessels at operation site; this is known as secondary
hemorrhage. Treatment involves managing the infection, but exploratory
operation is often required to legate bleeding vessels.
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3. GENERAL COMPLICATIONS OF OPERATIONS
2. INFECTION RELATED TO THE OPERATION SITE:
1. Minor Wound Infections:
The most common operative infection is a superficial wound
infection occurring within the first postoperative week. This
relatively trivial infection presents as localized pain, redness and
a slight discharge. The organisms are usually staphylococci or
streptococci derived from the skin.
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3. GENERAL COMPLICATIONS OF OPERATIONS
2. Wound Cellulites and Abscess:
More severe wound infections occur most commonly after
bowel-related surgery. often after the patient has left hospital.
These infections commonly present first with a pyrexia;
examination of the wound reveals either a spreading cellulites or
localized
abscess
formation.
Cellulites
is
treated
with
appropriate antibiotics.
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3. LATE INFECTIVE COMPLICATIONS
A late infective complication of surgery is a chronically
discharging wound sinus which emanates from a deep chronic
abscess. It usually relates to foreign material such as a nonabsorbable suture or mesh or sometimes necrotic fascia or
tendon. These sinuses commonly follow wound infections
where healing is delayed and incomplete.
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3. IMPAIRED HEALING
Factors Retarding Wound Healing:
Wound healing in general is retarded if blood supply is poor (as in arterial
insufficiency) or if the wound is under excess suture tension. Other Factors
which may retard wound healing are long-term steroid therapy,
immunosuppressive therapy, previous radiotherapy, severe rheumatoid
disease, malnutrition and vitamin deficiency, especially of vitamin C.
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4. Incisional Hernia
Incisional hernia is a late complication of abdominal surgery. These
hernias usually become apparent within the first postoperative year but
sometimes develop as long as 5 years later; the overall incidence is about
10-15% of abdominal wounds. The hernia is caused by breakdown of the
repair to the abdominal wall muscle and fascia.
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4. Incisional Hernia
Predisposing factors are
abdominal obesity, distension and poor muscle quality, poor choice of
incision, inadequate closure technique, post-operative wound infection
and multiple operations through the same incision.
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5. SURGICAL INJURY
1. Unavoidable Tissue Damage:
Anatomical structures, particularly nerves, blood vessels and lymphatics,
may be unavoidably damaged during operation. This is particularly true in
cancer surgery, illustrated by facial nerve damage during total parotidectomy.
2. Inadvertent Tissue Damage:
Structures may be inadvertently damaged
during operation. Examples include recurrent
laryngeal nerve damage during thyroidectomy
and trauma.
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5. SURGICAL INJURY
3. INADVERTENT OPERATING THEATRE TRAUMA
Injuries resulting from falls from trolleys or operating table during, positioning.
Injury to diseased bones and joints from manipulation or positioning..
Ulnar and lateral popliteal nerve palsies.
Electrical burns from wet or poorly contacting diathermy pads.
Excess pressure on the calf causing deep venous thrombosis.
Excess heel pressure causing pressure sores.
Cardiac pacemaker disruption by diathermy equipment
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COMPLICATIONS OF ANY SURGICAL CONDITION
1. RESPIRATORY COMPLICATIONS:
Up to 15% of patients suffer from respiratory complications associated with
general anesthesia and major operations. The most common of these are
atelectasis, pneumonia.
Effects of Anaesthesia and Surgery on Respiratory Function:
Anesthesia and surgery predispose to post-operative complications by
altering lung function and compromising normal defense mechanisms as
follows:
1. Lung tidal volume may be reduced by as much as 50%, depending on the incision site. Thoracic, upper abdominal and lower abdominal incisions (in
decreasing order of effect) particularly reduce, lung volume
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COMPLICATIONS OF ANY SURGICAL CONDITION
Effects of Anaesthesia and Surgery on Respiratory Function:
2. Lung expansion is reduced by the supine posture during and
after operation, pain, abdominal distension, abdominal
constriction by bandages and the effects of sedative drugs.
3. Diminished ventilation and pulmonary perfusion result
in reduced gaseous exchange.
4. Airway defenses are compromised by loss of the cough
reflex and diminished ciliary activity, which both lead to
accumulation of secretions.
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COMPLICATIONS OF ANY SURGICAL CONDITION
2. Atelectasis:
Pathophysiology and clinical features:
Atelectasis or alveolar collapse occurs when airways become
obstructed and air is absorbed from the air spaces distal to the
obstruction. Bronchial secretions are the main cause of this
obstruction. Predisposing factors include shallow ventilation,
loss of periodic hyperinflation, inhibition of coughing and
pooling of mucus. All of these are particular problems after
thoracic and upper abdominal surgery.
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COMPLICATIONS OF ANY SURGICAL CONDITION
Prevention and treatment of atelectasis:
Atelectasis
is
best
prevented
by
preoperative
and
postoperative physiotherapy for patients undergoing major
surgery. This includes deep breathing exercises, regular
adjustments of posture and vigorous coughing. During
physiotherapy, wounds should be supported by the patient’s
hand.
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COMPLICATIONS OF ANY SURGICAL CONDITION
5. THROMBOEMBOLISM
Pathophysiology
Venous thromboembolism is a major cause of complications
and death after surgery or trauma. Venous blood is normally
prevented from clotting within the veins by a complex series of
mechanisms which include local inhibition of the clotting
cascade, prompt lysis of small clots that do form, and continues
flow of blood.
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COMPLICATIONS OF ANY SURGICAL CONDITION
5. THROMBOEMBOLISM
Predisposing factors for deep vein thrombosis and pulmonary
embolism
*Trauma and surgery (complex systemic effects)
*Direct trauma to the pelvis and lower limbs, especially
fractures
*Previous venous thromboembolism
*Pre-existing lower limb venous disorder causing stasis
*Venous stasis during general or regional anesthesia (loss
Of calf muscle pump and postural pressure on the calves)
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COMPLICATIONS OF ANY SURGICAL CONDITION
5. THROMBOEMBOLISM
Predisposing factors for deep vein thrombosis and pulmonary
embolism
Malignant disease
Immobility. e.g. bedbound patients after operation or stroke
Cardiac failure
High- estrogen, oral contraceptive piles, estrogen treatment
Pregnancy
Pelvic masses
Obesity
Dehydration
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COMPLICATIONS OF ANY SURGICAL CONDITION
DEEP VEIN THROMBOSIS
Deep vein thrombosis in the lower limbs (DVT) is often silent
with the classic clinical features found in only half the cases.
These include swelling of the leg, tenderness of the calf muscles,
increased warmth of the leg, and calf pain on passive
dorsiflexion of the foot (Homan’s sign). The presence of these
features indicates that venous occlusion has extended at least as
far as the popliteal veins.
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COMPLICATIONS OF ANY SURGICAL CONDITION
DEEP VEIN THROMBOSIS
Occlusion of the ilio-femoral veins tends to produce diffuse and
sometimes massive swelling of the whole lower limb. In addition,
there is tenderness over the femoral vein in the groin. In severe
cases, the leg becomes painful and white boggy with edema.
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COMPLICATIONS OF ANY SURGICAL CONDITION
Pulmonary embolism
The classic picture of pulmonary embolism (PE) is sudden dyspnoea and
cardiovascular collapse, followed by pleuritic chest pain, development of a
pleural rub and haemoptysis. ECG may show evidence of right heart strain.
Prevention of Venous Thromboembolism
These include early postoperative mobilization, adequate hydration and
avoiding calf pressure. For patients at higher risk, specific prophylactic
measures should be taken to reduce the risk of deep venous thrombosis (and
consequent pulmonary embolism).
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COMPLICATIONS OF ANY SURGICAL CONDITION
Prophylactic measures include the following:
1. Low-dose subcutaneous heparin.
2. Calf compression devices - several pneumatic and electrical devices are
available for intra-operative calf compression to simulate normal muscle
pump activity. These have the advantage of being non-invasive and easily
applied to all patients, even those at low risk, but their efficacy is less than
low dose heparin
3. Graded-compression “anti-embolism’ stockings
They offer a suitable level of prophylaxis for patients at low or moderate
risk. The stockings must be worn during operation as well as during the
early postoperative period.
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COMPLICATIONS OF ANY SURGICAL CONDITION
PRESSURE SORES:
Pathophysiology:
Elderly, debilitated and other bed-bound patients are extremely susceptible to
pressure sores (bed sores), particularly over bony prominences such as the
sacrum and heels.
Diminished protective pain response plays an important part.
Tissue necrosis and subsequent failure to heal result from a combination of
factors including recurrent pressure ischemia, poor tissue perfusion and
malnutrition.
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COMPLICATIONS OF ANY SURGICAL CONDITION
Prevention and management of pressure sores:
Relieving pressure on the heels
Regular change of posture - for most patients, this
involves encouragement to get out of bed, at least into a bedside
chair, and to mobilize beyond this as much as possible.
Regular checking of pressure areas and local massage.
Management of incontinence
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